Vessels of brain and spinal cord Brain ventriclesanat.lf1.cuni.cz/souhrny/alekls1101.pdf ·...
Transcript of Vessels of brain and spinal cord Brain ventriclesanat.lf1.cuni.cz/souhrny/alekls1101.pdf ·...
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Vessels of brain and spinal cordBrain ventricles
Prof. MUDr. Rastislav Druga, DrSc.MUDr. Veronika Němcová, CSc.
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Frontal section through the falx cerebri and brain coverings
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Falx cerebri
overbridging vein
periosteum SSSarachnoid granulations
dura matersubdural space
arachnoid
pia mater
overbridging vein
subarachnoid space
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Obaly míchySpinal cord - meninges
Endorhachis
Cavitas epiduralis – venous plexuses
Dura mater spinalis
Cavum subdurale
Arachnoidea – lig. denticulatum
Cavitas subarachnoidalis
Pia mater spinals
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Internal carotid
and
Vertebrobasilar system
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Cévy cieculusBrain arteriesWillis circuit
• Communication between Communication between vertebral and a. carotis vertebral and a. carotis interna systemsinterna systems
• Anterior and posterior Anterior and posterior communicating arteries communicating arteries allow blood to flow allow blood to flow between both systems between both systems (PCA) or between right (PCA) or between right and left vessels (ACA)and left vessels (ACA)
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CT – AG, 3-D
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Cerebral arterial territories
a.cerebri anterior
a.cerebri media
a. cerebri posterior
a. choroidea anterior
a.cerebellaris superior
a.cerebellaris inferior posterior
a.cerebellaris inferior anterior
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Circulus arteriosus
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Circulus arteriosus Willisi – četnost aneurysmat
1
3
5
6
2
4
87 A. cerebelli sup.
9 A. cerebelli inf. ant.
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Aneurysmata lokalizace
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Aneurysma - léčbaEndovascular occlussionClip
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Aneurysma – stent, recoiling
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Intravascular coiling
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A-V malformace
peroperačně
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Výstupy hlavových nervů a cévy na ventrální straně mozkového kmeneCranial nerve origins and arteries on the ventral part of the brainstem
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NMR – angoigrafie na sagitálním řezu
1 - a.carotis interna
2 - a.vertebralis
3 - sinus cavernosus
4 - canalis caroticus
5 - a.cerebri anterior
6 - a.cerebri posterior
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Thomas Willis (1621–1675)
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Sir Christopher Wren
Christopher Wren
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The home of Thomas Willis from 1657 to 1667
.
Oxford, Beam Hall
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Thomas Willis
• Neuroanatomical terms coined by Willis• Anterior commissure | Cerebellar peduncles | Claustrum | Corpus
striatum | Inferior olives (corpora teretia) | Internal capsule | Medullary pyramids | Nervus ophthalmicus | The word 'neurology' | Optic thalamus | Spinal accessory nerve | Stria terminalis (taenia cornua) | Striatum | Vagus nerve
• Pathologies recognized by Willis• Achalasia of the cardia (achalasia of the oesophagus) | Akathisia
(restless legs syndrome, Ekbom's syndrome) | Symptoms of myasthenia gravis | Paracusis Willisii. Occurs in deaf patients whose hearing improves in the presence of noise, indicating osteosclerosis | Diabetes mellitus | Abnormalities of the brains of patients with congenital mental retardation | Unilateral degeneration of the cerebral peduncle in a case of long-standing unilateral paralysis | Symptoms of malaria | Distinctions between typhoid and puerperal fevers
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5 Vena anastomotica sup. (Trolardova)
6 Vena anastomotica post. (Labbéova)
1- superior sagittal sinus2-transverse sinus3-sigmoid sinus4-superficial middle cerebral vein
Brain veins
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Brain veins - % of thrombosis
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Trombosa sinus sagittalis superior
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Trombosy vv. cerebri superiores
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Labbé
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superior sagittal sinus
internal cerebral veins
vein of Labbé
sphenoparietal sinus
Cerebral Venous territories„rough guide“
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1. Epidurální hematom
2. Subdurální hematom
3. Subarachnoidální hematom
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Epi
Subd
Subar
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Spinal cord arteries
Yoshioka K et al. Radiographics 2003;23:1215-1225
©2003 by Radiological Society of North America
Artery of Adamkiewicz (a. radicularis magna) from the a. intercostalis post. at the level Th9–L1
a. iliolumbalis
lumbal artereries
aa. sacralis lateralis
vertebral art.
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Longitudinal system
Segmental (radicular)
system
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Tepny míchySpinal cord -arteries
spojky vasocoronae
5 podélně probíhajících kmenů5 longitudinal truncs
r. spinalis
a. spinalis anterior
aa. spinales posteriores
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Vertebral veins
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basivertebral veins
basivertebral vein
Anterior external vertebral venous plexus
Internal vertebral venous plexus
Posterior external vertebral venous plexus
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no valvesanastomosesspreading of infection and cancer
Vertebral veins
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Vertebral venous plexuses• no valves, a lot of anastomoses• anastamoses with venous plexus around sacrum and
pelvis • 1) in the vertebral canal in the epidural space (plexus
venosi vertebrales interni)• 2) outside the spine (plexus venosi vertebrales externi)• 3) in the bodies of vertebrae (venae basivertebrales)
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Liquor cerebrospinalis Liquor cerebrospinalis Produced by the choroid plexusProduced by the choroid plexus
Ventricles and subarachnoid space 140 mlVentricles and subarachnoid space 140 mlPhysical support of the brain (floats within the fluid)Physical support of the brain (floats within the fluid)Channel for chemical communication within the CNS Channel for chemical communication within the CNS
(neurons- fluid- walls of ventricles – neurons)(neurons- fluid- walls of ventricles – neurons)
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Liquor circulationMRI
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Choroidal plexus – lateral ventricles, 3rd ventricle, 4th ventricle
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Granulationes arachnoidales
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Dural sheaths
Kořenové pochvy
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Dural sheaths
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CEREBRAL VENTRICLES
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Cornu frontale ventriculi lateralis
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Pars centralis a cornu temporale
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III. ventricle
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Cirkumventrikular organs
uncomplete blood-brain barrier
area postrema vomitingorganum subfornicale fluid balanceorganum vasculosum laminae terminaliseminentia mediananeurohypophysiscorpus pineale
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MRI – T2
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Cisternae subarachnoidales
cerebellomedularis
Cisterna fossae lateralis cerebriCisterna pontisCisterna laminae quadrigeminaeCisterna corporis callosi
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60-year woman with worsening cognitive impairment and gait disturbance
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Substantial enlargement of the 3rd, 4th, and lateral ventricles. Relative normal appearance of sulci for age. No evidence of substantial vascular pathology.
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• Classical clinical triad of dementia, gait disturbance, and urinary incontinence is seen with normal pressure hydrocephalus.
• Symptoms result from distortion of white matter by distended ventricles. • Patients commonly have a history of prior SAH or meningeal infection. • Gradient between ventricular system and subarachnoid space due to
incomplete subarachnoid block. • Radiographic key: Diffuse ventriculomegaly out of proportion to sulcal
prominence. • Not a radiographic diagnosis. Diagnosis made by improvement of
symptoms after shunting. • Radioisotope cisternogram shows early entry into the lateral
ventricles with persistence at 24-48 hours and delayed ascent to parasagittal regions.
• Flow void can be seen through the aqueduct of Sylvius on MR due to increased flow velocity
Normotensní hydrocephalusNormal pressure hydrocephalus